**6. Comorbidities**

There are not many studies about comorbidities in MPA. The literature results indicate that the specific phobia, generalized anxiety disorder, panic disorder with/ without agoraphobia, and major depression disorder (but not dysthymia) are the common comorbidities [3, 52].

Furthermore, one third of the subjects that show severe MPA also show a generalized anxiety disorder. There are studies that point to a prevalence of a 19 and 20% comorbidity of social phobia and depression, respectively [53]. This social phobia prevalence among musicians is about 10 times more prevalent than the general population.

On the other hand, more recent studies indicate that the generalized anxiety disorder is the strongest MPA predictor among all major DSM-5 anxiety types [54].

There is a model that proposes three MPA subtypes: MPA1, which is a variety restricted to the focus on the performance itself; MPA2, which establishes connections between (and with) social anxiety/social anxiety disorder; and MPA3 which establishes close relations with other nosologies in the anxiety spectrum such as panic disorder with or without depression [3, 55]. These relations configure a potential MPA worsening as other disorders manifest themselves, in a way that MPA will not necessarily convert itself in another anxiety disorder or establish a comorbidity but there is this potential.

#### **7. Conclusion**

These data indicate that MPA is complex and multifactorial. Probably the first symptoms are of an early start. Consequently, there is the importance of spreading the information about MPA, especially in the family level and the school/ academic environment, contexts where the future professional musicians are formed.

Preventively, in the family environment as well as in the schools, one must build relationships that privilege the well-being, motivation, and reception of psychic distresses.

MPA has a worrying prevalence of about 20% among the professional musicians. This number can mean some million subjects! The preventive strategies, the qualitative and quantitative evaluation, and the management of the already installed situations are of upmost importance.

Currently there are countless strategies to approach MPA. They go from the traditional psychotherapy strategies (cognitive, behavioral, and cognitive-behavioral therapies) to the pharmacological resources. New approaches signal a new outlook in this area with the therapeutic use of cannabidiol, melatonin, botulinum toxin, neurofeedback, and transcranial stimulation.
